IN SO MANY WORDS

Zeiss’ Ludwin Monz

In So Many Words is a timely talk with an ophthalmic industry thought leader.

When Ludwin Monz, PhD, joined Carl Zeiss Meditec in 1994 as a research scientist, the unification of Berlin was three years old and Zeiss was three years away from introducing its first OCT system. He is a man accustomed to witnessing history in the making. The latest important notch in this 170-year-old company’s timeline is the consolidation of its ophthalmic products line into one strategic business unit. (See sidebar) Now president and CEO, Dr. Monz says this newly consolidated business unit will help ZEISS further advance ophthalmology and optometry.

Ludwin Monz, PhD

Ophthalmology Management: Tell us about Zeiss.

Ludwin Monz, PhD: Zeiss turns 170 years old this year. Our founder developed and manufactured high-quality microscopes. There’s a long series of technologies invented here — slit lamp, surgical microscope, optical biometry — and Zeiss introduced OCT to the ophthalmic market. Zeiss invented the refractive procedure SMILE, so it’s really many innovations over this long time.

But these are useless without understanding how to use them. Having the technology is one thing, but to make it useful and then help advance either diagnostics or treatment of ophthalmic diseases, that is the other. To have a reliable and clinically useful solution is the real challenge, and that is what Zeiss is focused on and what Zeiss is good at.

OM: Explain how, please.

Dr. Monz: When we develop a new product or technology and bring it to market, we ascertain clinical evidence about its effectiveness. Then we use that clinical data and bring it to the medical community, because we believe the clinical evidence is its most fundamental feature.

We realize the other aspects — saving time, work flow optimization and reimbursement — are important for our customers because they have to invest in the new technology. We provide information and give advice, for example, regarding how to become efficient in data management. We want our customers to make best use of the products. We provide hands-on training as well as technical support for the life of the product.

OM: You have said OCT-A was the key technology in your new Ophthalmic Devices Strategic Business unit.

Dr. Monz: Well, it’s one key technology. OCT technology has revolutionized diagnostics in ophthalmology. When we first introduced it in the mid-1990s, it was about getting the technology to produce retinal images.

But ophthalmology had to learn how to read these images and how to make clinical use of them. It took between five and 10 years to really develop this, and once the clinical understanding was there, how to use OCT technology, it didn’t take long to spread OCT throughout ophthalmology and to become the absolute standard.

What has happened is while the technology has improved, so has the image quality, and so its application has become broader. We now have OCT technology with biometry as well as intraoperatively.

OM: In the diagnostics market, there is heightened price and competitive pressure. How do you stay dominant?

Dr. Monz: I believe there are various aspects. One is technology. We keep driving development of these technologies further, which is difficult in an environment where many companies have similar approaches, and there are very good alternative technologies out there. So, that’s challenging economically. We try to work closely with customers, and that’s the idea behind the combined swept-source OCT (SS-OCT) and OCT-A platform and the Advanced Retina Imaging network: to support the work that clinical researchers produce using this platform, and which helps us develop the next generation of products.

Healthcare providers are looking for ways to increase efficiency and reduce costs. One approach is to come up with products and solutions that do this.

OM: Do you mention that first to physicians about Callisto eye, for example? Its economic benefits? How do you convince them that this is best for them in the long run?

Dr. Monz: It depends on the customer’s interest. Some are very much outcome oriented. In the case of using Callisto eye, this is a premium procedure, as are toric lenses. So it’s lucrative also from the surgeon’s perspective. And there’s a big need to get superior clinical outcomes because otherwise, patients would not be willing to pay for the procedure. Regarding Callisto eye, the major driver is improving clinical outcomes.

Two forces are at work here. One, doctors need to have good clinical outcomes to convince their patients that the money is well spent. Then, to make it work economically, the procedure must not take hours. We discuss both with the ophthalmologists.

OM: You have said you see two challenges for imaging the eye: further improvement of resolution of visualization and the ability to visualize structures or media hidden in the eye.

Dr. Monz: If you look, for example, at SS-OCT, there is a degree of detail that is just amazing. You can see things that were invisible before.

With OCT-A, you can see blood flow in tiny vessels, which are only a few microns in diameter — 10-15 times smaller than the diameter of the average human hair. So it’s tiny and you can see what’s going on there.

With a higher resolution and more detail in the imaging, these will produce better insights, better understanding of diseases, which will lead to treatment.

With SS-OCT, you can also see hidden structures, so you also see the choroid which is below [the retina] and that provides additional information.

The other things hidden are membranes. So if you look into the eye just with the microscope, most membranes tend to be transparent. And with the intraoperative OCT, it’s visible.

OM: Is Zeiss interested in finding other diseases such as Alzheimer’s, because some people are able to locate it?

Dr. Monz: Yes, we are interested in that. We are also aware, for example, that with Alzheimer’s there’s some evidence it can be detected through the eye. Clinical research is needed to prove it works, and so here we also need partners.

OM: Are you considering other ophthalmic fields?

Dr. Monz: We want to cover all ophthalmic fields. And, yes, in general, I would say there’s certainly room for further extending our portfolio. OM

The Mazzo factor: the man leading ZEISS’ Global Ophthalmic Devices

James V. Mazzo

The man chosen to head Zeiss’ newly formed global ophthalmic devices unit, James V. Mazzo, was well considered. If it’s Zeiss’ intention, as a company press release notes, to have its new unit “led by a proven, experienced leader [who] will facilitate more effective customer service, more effective market penetration and global expansion,” then Mr. Mazzo fits the job description. He has worked with leading ophthalmic companies and he sits on many boards, including the ASCRS Governing board and the AAO Foundation Advisory board.

Mr. Mazzo, late of AcuFocus by way of Abbott, AMO and Allergan, says his goal is to move the dynamic Zeiss product line “a little quicker” in the US; by leveraging its extensive experience in innovation and ophthalmics. “If I talk to US-based physicians, I’m not sure they’re as knowledgeable about Zeiss as maybe a Japanese or German physician. We’re going to spend a little more time in the US educating the physician about Zeiss.”

And part of that education will be about efficiency — how Zeiss is focusing on helping its customers run a more efficient practice with its products. “You hear more and more that doctors need to be more efficient in their practices. We’re going to be partners there. Well, how do you become partners? Number one, you determine their needs. We’re the leader in diagnostics — with technologies that help doctors to more efficiently diagnose to expedite the best solution for the patient.” None of this will happen, he says, without spending lots of time talking to customers.

Mr. Mazzo also wants to round out the Zeiss ophthalmic line of products via mergers and acquisitions. “If you look at technologies, the biggest growth is in retina, we are in it; glaucoma; we are in it; dry eye, not so much. We want to expand the breadth and depth of these categories,” he says.

And by breadth and depth he means developing technologies that get to the diagnosis quicker. Physicians, he says, haven’t the extra time trying to figure out what issues a patient is having. The costs of running a practice are higher, patients’ demands are higher.

“The best way is to improve diagnosis. If we can help [physicians] do that better, then this will help them find the best solution for their patient.“